title: Use patterns of long-acting bronchodilators in routine COPD care: the OUTPUL study.
abstract: BACKGROUND
  COPD is the fourth leading cause of death in the world. In the case of exacerbations or persistent symptoms, regular treatment with long-acting bronchodilators is recommended to control the symptoms, reduce exacerbations and improve health status. Objectives. To describe patterns of drug utilization among patients diagnosed with COPD, to measure continuity with long-acting bronchodilators, to identify determinants of not receiving long-acting therapy continuously.
  
  
  METHODS
  We identified a cohort of patients discharged from hospital with diagnosis of COPD between 2006 and 2008. Patients were observed for a two-year follow-up period, starting from the day of discharge. Follow-up was segmented in six-month periods, in order to dynamically evaluate prescription patterns of Long-Acting Beta-Agonists (LABA), tiotropium, and inhaled corticosteroids. Patients with prescriptions for LABA and/or tiotropium in each of the six-month periods were defined as "continuously treated with long-acting bronchodilators." The degree of drug treatment coverage was measured through the Medication Possession Ratio (MPR). Logistic regression was performed to identify determinants of not receiving long-acting bronchodilators continuously.
  
  
  RESULTS
  A total of 11,452 patients diagnosed with COPD were enrolled. Only 34.8% received long-acting bronchodilators continuously. The MPR was greater than 75% in 19.6% of cases. Among the determinants of not receiving long-acting bronchodilators continuously, older age and co-morbidities played an important role.
  
  
  CONCLUSIONS
  In clinical practice, the COPD pharmacotherapy is not consistent with clinical guidelines. Medical education is needed to disseminate evidence-based prescribing patterns for COPD, and to raise awareness among physicians and patients on the health benefits of an appropriate pharmacological treatment.
authors.affiliation: 1Department of Epidemiology, Lazio Regional Health Service , Roma , Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Di Martino
authors.forename: Nera
authors.initials: N
authors.lastname: Agabiti
authors.forename: Lisa
authors.initials: L
authors.lastname: Bauleo
authors.forename: Ursula
authors.initials: U
authors.lastname: Kirchmayer
authors.forename: Silvia
authors.initials: S
authors.lastname: Cascini
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pistelli
authors.forename: Vittoria
authors.initials: V
authors.lastname: Colamesta
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Patorno
authors.forename: Luigi
authors.initials: L
authors.lastname: Pinnarelli
authors.forename: Danilo
authors.initials: D
authors.lastname: Fusco
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Perucci
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003692:Delayed-Action Preparations / Q000627:therapeutic use*; D004338:Drug Combinations; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D000069447:Tiotropium Bromide; D016903:Drug Monitoring
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D004338:Drug Combinations; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide
keywords: COPD; adherence to clinical guidelines; clinical practice; inhaled corticosteroids; long-acting bronchodilators; medication possession ratio